How EDs Work

It was morning in Honduras on my most recent medical mission.  I padded in my pajamas to the room where the coffee was supposed to be, but alas it wasn’t out yet.  I went back to my room, got dressed, back to the coffee table- still no joe. Somewhat miffed, I went to brush my teeth.  Finally on that third trip back, now really irritable, there was finally coffee!  Later that morning, I stood in the clinic doorway and greeted a family that was all smiles, though covered with dust from their three-mile walk from the open-air hut they called a home.  Makes my irritation over coffee pretty lame.

Anger over having to wait is a pervasive emotion in the Emergency Department too.  Families are already stressed about their sick child.  Then they have to wait for the doctor- sometimes an hour or two, sometimes more.  They really get steamed when  another kid passes them in the waiting room, being ushered back ahead of them.  What the hell’s going on??

Getting passed up touches on an under-current of frustration in our society.  While America is supposed to be class-less, everyone equally important, we see that’s not the case.  In court, the rich can afford better lawyers, and beat raps that would have us behind bars for years.  In the airport, there’s first class lounges and airplane seats, and there’s the rest of us in crowds and cramped seats, only a tiny bag of pretzels for our trouble.

But the ER is a true meritocracy. We treat emergencies first- kids who have real trouble breathing, compromised airways, or shock from dehydration or blood loss.  If we don’t see them first, they can get dangerously more ill, and even die. The front of the ER is called “triage,” a military term for sorting casualties to maximize lives saved- the most critical go first, the mildly injured wait, and the dead are dead.

You’ll sometimes see an apparently well child go ahead of you.  A kicker in Pediatric Emergency Medicine is that often the first signs of distress are subtle- mild trouble breathing, hidden signs of shock, before the quick and inevitable “crash.”  The child jumping to the head of the line may look okay from afar, but really isn’t.

Once a mom complained to me that at a previous Emergency Department visit, she waited for hours with her child.  When finally brought back, they passed the nurse’s station where the nurses and doctors were laughing and leisurely eating pizza, like they were at a Superbowl party. They didn’t seem to be busy with many other patients either.  Since hearing of this apparent outrage, I furtively eat my meals in our back conference room.

In defense of that ER crew, they may have just finished resuscitating a major trauma, having spent hours putting in tubes and lines, taking the patient to CT and back, giving blood and meds, and calling in surgeons.  Finally they get to eat a meal, and while they’re at their jobs, what’s wrong with some camaraderie after a stressful event?

As I mentioned above, I just returned from my annual medical mission to Honduras. In the mountains, when a mom’s child gets sick, she has nowhere to go- no ERs, no walk-in clinics, no medical care at all.  Once a year we show up at a local school house, and people walk miles to see us.  They wait hours in line in the hot sun. To make time go by, we have a station where the kids get crayons and paper and make pictures.  They pass around their creations and chatter with everyone around, having a better time than any tablet could provide.

To survive your visit to an ER, some patience and perspective is in order.  If a child is truly sick, they’ll be seen quickly.  If you’re not rushed right back, count your blessings- the triage crew has assessed your child as not being gravely ill.  If you get passed up by another, know that that kid is worrying us, but we haven’t forgotten you- the computer tracker assures that. Better still, if your child doesn’t have an emergency, like only having a fever, cough, or rash, see your doctor the next day.  If they have ear pain or a sore throat, give them ibuprofen or acetaminophen (Tylenol). And be thankful that, unlike coffee growers in the mountains of Honduras, you’ve got somewhere to go.

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